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March 26, 2026BMJ Global HealthOpen Access

State capacity and health system financing: a cross-country analysis

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Authors

SMSumit MazumdarAHAkseer HussainMSMarc Suhrcke

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Overview

Cross-country analysis finds stronger state capacity boosts health financing, suggesting governance reforms are vital.

Key Points

  • This study explores how different dimensions of state capacity influence health system financing across countries.
  • Analyzed global panel data from 141 countries (2000-2020)
  • Examined multiple dimensions of state capacity
  • Utilized fixed-effects and random-effects regression models
  • Assessed government health expenditure and out-of-pocket health spending
  • Stronger state capacity linked to higher public health investment
  • 1 SD increase in bureaucratic quality results in 2.6 percentage-point lower OOP share
  • Improvements in government effectiveness and property rights associated with lower OOP shares
  • 1 SD increase in state fragility linked to a 32% lower government health expenditure per capita
  • Aggregate state capacity index positively correlated with increased public health spending

Cite This Study

Mazumdar et al. (2026) studied this question.

synapsesocial.com/papers/69c4cc85fdc3bde448917d2bhttps://doi.org/10.1136/bmjgh-2025-020101
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